[Lung contusion--an indication for resection?]

Pulmonary contusion is the most common injury in blunt chest trauma. Parenchymal injury and systemic inflammatory response lead to respiratory insufficiency and secondary pneumonia. Early detection and intervention to minimize progression of lung consolidation with a low threshold for mechanical ventilation optimize treatment results. Between 1990 and 2000 55 thoracotomies or thoracoscopies for chest trauma were performed. In 26 patients pulmonary contusion with hematothorax (n = 13), endobronchial bleeding (n = 9), bronchopleural fistula (n = 6), bronchusruptur (n = 2) or other contusion related injuries (n = 6) was responsible for the thoracotomies. We performed 12 lobectomies, 1 pneumonectomy, 11 parenchymal suture and 2 decortications. Preoperatively a bronchoscopy for the localisation of the bleeding and disclosure of central airway injury is mandatory. The benefit of bronchoscopy guided blocking of the bronchus for endobronchial bleeding is unclear. Video assisted procedures are not useful for massive bleeding or anatomical resections.